Peds - 16 - Sports Injuries in Children

GENERAL INFORMATION

Over 7 million students participate in High School sports

30 million children and teens participate in some form of organized sports

Increased pressure to perform at higher levels and be competitive
–More opportunities to participate in community sports
–Younger children are pushed harder by coaches and parents

3.5 million children < 15 y/o treated for sports injuries/year

___ of ALL injuries incurred in childhood are sports-related

Basketball and Football top of list

Other sports thought to be safe can cause injury (tennis, volleyball, swimming, dance)

SERIOUS AND CATASTROPHIC INJURIES

Spinal cord injuries

Back injuries

TBI

Death

Typical Injuries:

Overuse injuries

Fractures and sprains

Knee, shoulder and joint pain

Shoulder separations and dislocations

Torn ligaments (ACL tear)

Hip pain and injuries

FRACTURES

Children have soft bones

___ plate injuries:
Weak link
Overuse
-Decreased coordination/positioning

Other fractures

___-Harris Classification

Type 1 - A complete physeal fracture with or without displacement

Type 2 - A physeal fracture that extends through the metaphysis, producing a chip fracture of the metaphysis, which may be very small

Type 3 - A physeal fracture that extends through the epiphysis

Type 4 - A physeal fracture plus epiphyseal and metaphyseal fractures

Type 5 - A ___ fracture of the growth plate

Sport-Related Fractures:

Common in adolescents
Particularly males
low-energy injuries
___ limb > ___limb
Few require operative treatment


Injury. 2010 Aug;41(8):834-8. Epub 2010 May 23.The epidemiology of sports-related fractures in adolescents.WoodAM, Robertson GA, Rennie L, Caesar BC, Court-Brown CM

Other Fractures

Proximal, Middle, Distal

Transverse, Spiral, Oblique, Comminuted, Segmental

Gymnastic injuries

___ of MC
___ of growth plate

PAIN

Don’t “play through”pain

Don’t ignore signs and symptoms
–ICE
–Over the counter pain relievers

Premature arthritis/boney deformities

___ - a joint condition in which a piece of cartilage, along with a thin layer of the bone beneath it, comes loose from the end of a bone.

Caused by reduced blood flow to the end of a bone, this occurs most often in young men, particularly after an injury to a joint. The knee is most commonly affected, although this can occur in other joints, including your elbow, shoulder, hip and ankle.

If the loosened piece of cartilage and bone stays put, lying close to where it detached, you may have few or no symptoms of this, and the fracture can often heal by itself. Surgical repair may be necessary if the fragment gets jammed between the moving parts of your joint.

Mayo clinic website

Hip Pain

Coxa plana or Legg-Calve-Perthes disease
Trochanteric bursitis - runners and dancers
Slipped femoral capital epiphysis
Congenital dislocation of hip
Relevant anatomy of the hip - all the bursa, tendons, ligaments around the hip joint

Shoulder Dislocations

Sprains and Strains

___ are common in children. The ligaments are stretched but not torn

Sprains the ligament is partially torn

Ruptured Tendons

Thompson test
Fully Ruptured
Partial Rupture
Repaired

Torn Ligaments

Other Common Injuries

Impingement (Hip)
Hip impingement – overgrowth, excessive bone around lip of acetabulum. Excessive bone at head/neck of femur, 3rd – excess bone at head/neck and labrum

Labral Tears

Procedures


ACL reconstruction
Shoulder stabilization
Arthroscopy
Cartilage restoration
Advanced, minimally invasive surgical techniques tailored for the young athlete
Advanced techniques for hip impingement

TREAT-ACUTE signs and symptoms

REFER when necessary

REHABILITATION
–Range of motion-stretching
–Strengthen
–Postural reactions
–Task related exercise
–Fine tune for athletic performance

return to sport

Decisions regarding return to play vary according to profession, child, clinical factors, and sport-related factors:
___ parent, ___ parent, ___ equipment

previous injury, musculoskeletal maturity, game importance, position played, team versus individual sport, and time since injury.

Clin J Sport Med. 2010 Jul;20(4):249-55.Clinical management of musculoskeletal injuries in active children and youth.MazerB, Shrier I, Feldman DE, Swaine B, Majnemer A, Kennedy E, Chilingaryan G

conclusion

Current literature lacks well designed controlled studies:
1) to address issues relevant to the pediatric injured athlete
2) to determine the optimum program for each sport-related injury/diagnosis to expedite return to sport

Eur J Phys Rehabil Med. 2010 Jun;46(2):133-45. Epub 2010 Feb 18.Rehabilitation of pediatric musculoskeletal sport-related injuries: a review of the literature.Cohen E, Sala DA

Pediatric Running Injuries

The young athlete with open growth plates is vulnerable to unique overuse injuries involving the apophyses, articular cartilage, and growth plate

Current guidelines for overuse injury prevention in young athletes are primarily based on consensus and expert opinion.

Clin Sports Med. 2010 Jul;29(3):499-511.Pediatric running injuries.SetoCK, Statuta SM, Solari IL